Healthcare Provider Details

I. General information

NPI: 1235225269
Provider Name (Legal Business Name): LAWRENCE T. KACMAR M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3965 75TH ST SUITE 103
AURORA IL
60504-7925
US

IV. Provider business mailing address

3965 75TH ST SUITE 103
AURORA IL
60504-7925
US

V. Phone/Fax

Practice location:
  • Phone: 630-375-1625
  • Fax: 630-375-1925
Mailing address:
  • Phone: 630-375-1625
  • Fax: 630-375-1925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARGARET M COOLEY
Title or Position: OFFICE MANAGER
Credential: LPN
Phone: 630-375-1625